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Montana rates for HCPCS G2083

Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $982.83 / $1,302.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,099.99 / $68,099.99 / $81,499.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.21 / $801.00 / $1,794.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.21 / $55.21 / $1,913.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.21 / $1,077.57 / $1,913.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $1,028.05 / $1,438.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.25 / $1,199.93 / $2,761.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.76 / $1,784.09 / $2,122.44